Provider Demographics
NPI:1073784708
Name:PEEL, JENNIFER LORRAINE (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:PEEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 MILLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2665
Mailing Address - Country:US
Mailing Address - Phone:817-492-9381
Mailing Address - Fax:
Practice Address - Street 1:1420 8TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4138
Practice Address - Country:US
Practice Address - Phone:817-920-0130
Practice Address - Fax:817-920-9953
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657769363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01062011OtherRAILROAD MEDICARE PROVIDER TRANSACTION ACCESS NUMBER
TXGRP 00N85XOtherMEDICARE GROUP NO.
TX1760488936OtherGROUP NPI
GRP 00T04ZOtherMEDICARE GROUP NO.
TXGRP 00N85XOtherMEDICARE GROUP NO.
TX8L12679Medicare PIN